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Let's have a look at the mechanism in an RTC for a spinal injury. The first thing we look at when we actually assess the patient is were they wearing a seatbelt or not. As you can see in this occasion, the seatbelt itself holds your pelvis in place and it also comes across the centre of your chest to hold the centre of your body and the upper part of your body in place. This is designed to keep you into the seat under impact. Unfortunately, the problem occurs that the upper part of the neck or the smallest and weakest part, the C-spine, still has flexation. And it also has a head on top of it, which gives it the same equivalent weight of a bowling ball. So when the car stops at high-speed, even though the seatbelt stops your body moving forward, your head and neck still travel forward. The head whiplashes, so you get the whiplash effect on your neck, and then you go back into the seat, and your head then impacts against the headrest, doing C-spine and upper neck damage.

If the seatbelt is not worn, the patient comes forward from the seat, the head hits the windscreen. The windscreen, being on an angle tends to break the neck back and then the patient gets thrown back into the car, and the neck and head go back the opposite way. So we get a double impact for a contracture effect where the head gets taken backwards and then forwards and hyperextends the upper part of the neck. The other part of the neck is where all of your vital nerves are situated. So if you break your C-spine, between three and five of the vertebrae, you won't even be able to breathe on your own, because that's where the respiratory centre, it passes through for you to be able to breathe. And this is what, unfortunately, happens in an awful lot of high-speed crashes in particularly where seatbelts are not worn. So look for the wreckage again. Seat belts, were they being worn? Bulls-eyes on the windscreens, have they hit the screen? What impact has occurred on that particular vertebral column? And read that wreckage as to the damage on the patient.

Signs and symptoms. Because it's your main vertebral column that all of your nerves fit down. The first sign and symptom people look for is pins and needles. Any sensation rubbing on a spinal nerve will create a sensation of pins and needles in the hands or the hands and the feet. They also look for movement. Can the patient move? So we do a test basically, movement and sense. Touch the back of the hand, and can they feel you touching the back of the hand? Hard or soft. If you pull a hair, it should be a painful stimulus. If it's a nice gentle rub, and they should be able to pick that up. If the channel of information going from the hand back to the brain and back to the hand is correct. First, we should feel a sensation. Second, we should be able to move the fingers on command. We don't want to tell the patient which handle, which foot we're touching. We just touch the hand. So is the information we get back is accurate. Can they move the fingers and can they feel you touching the hand?

Then we move down to the feet, and we do the feet independently. Can they move the toes? Can they feel you touching their leg? That way, we can test movement sensation from lower limbs and upper limbs. And we can also test the pins and needles, and strain sensations, which gives us a good indicator along with a number of other checks, whether there is a high potential for the spinal injury. And if so, what precautions are we going to take to manage that patient on extrication to look after their back. Also, one thing that needs to be remembered, modern cars now have airbags, and seatbelt tension is fitted, to most cars are standard. And they are designed to try and help minimize the damage to neck, back, sides, pelvises, and everything else. So bare that in mind. First of all, have they been deployed? It takes a certain speed and a certain impact to actually deploy the airbag. All cars will have steering wheel airbags these days, but they also have passenger airbags. They quite often have airbags in the seat, the side of the seat, and also side-impact airbags that come down to the sides of the windows, if you get a side-impact into a lamp post or a tree.

So, have the airbags been deployed? If they have, that is an indication that it was quite high-speed. And the second thing is to look for the damage to the patients. Quite often, the airbag will blow up into the patient's face, to cushion their face from hitting the screen or the steering wheel which can give your patient black eyes. It can also give you nose bleeds. But also, the steering wheel once, when they go off, can also sometimes impact on the back of the patient's hands, creating bruising or small crooks on the back of the hand, from the airbag exploding lost over driving. So look for airbags. One thing to be cautious of, if the airbags haven't deployed, it doesn't mean they won't. So remember, safety comes first. The first service will always carry seat steering wheel covers that go over the steering wheel before we start to work on the patient, just in case it delay deploys. They can deploy twice. Some will actually secondary deploy. And others, sometimes, if there is a malfunction with the detonators, can actually go off at the later date. So please be aware. Safety with steering wheel and airbags.

  • FPOS Extended unit 3 LO6.1 and 6.2